Urine Culture Rw 2014
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Transcript of Urine Culture Rw 2014
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Pemeriksaan Bakteriologik Urin
Lab. Mikrobiologi
FK Universitas YARSI
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Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin
Sampel
Pemeriksaan Makroskopis
Pemeriksaan Mikroskopis
Kultur
Tes sensitivitas
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When is urine culture helpful?
Urine culture should be performed for:
1. Women with a UTI with complicating features
2. All pregnant women
3. Men with suspected UTI
4. Suspected acute pyelonephritis
5. Prostatitis
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Complicating features in women include:
Abnormal urinary tract e.g. stone, reflux, catheter
Impaired host defences e.g. pregnancy, diabetes, immunosupression,
Impaired renal function,
Suspicion of pyelonephritis,
More than three UTIs in one year, or
UTI recurrence within two weeks.
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Urine culture is recommended for pregnant
women
Women with asymptomatic bacteriuria in early pregnancy have a 20-30 fold increased risk of developing pyelonephritis, premature delivery and low birth weight infants.
All pregnant women should be screened for asymptomatic bacteriuria at 12-16 weeks gestation.
If bacteriuria is detected by screening, the patient should be treated and a urine culture performed monthly throughout the pregnancy
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Urine culture is indicated for lower UTI
in Men
All UTIs in men are considered complicated, therefore a urine culture is indicated, even if the urine dipstick is negative.
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A urine culture is indicated when acute
pyelonephritis is suspected
Dipstick testing of the urine may be useful if clinical findings are equivocal
Antibiotics should be commenced while waiting for culture results
Post-treatment urine cultures are recommended one to two weeks after antibiotic therapy
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Signs and symptoms of acute prostatitis include fever, dysuria, pelvic or perineal pain, and cloudy urine
Urine culture should be performed
If urine culture is negative, STIs (C. trachomatis, N. gonorrhoea) should be excluded.
Acute Prostatitis
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Chronic prostatitis should be considered in men with dysuria and frequency, no signs of acute prostatitis, and with recurrent UTIs.
Gram-negative bacilli are most common cause, but enterococci and Chlamydia have been associated with chronic infection.
Chronic Prostatitis
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Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin
Sampel
Pemeriksaan Makroskopis
Pemeriksaan Mikroskopis
Kultur
Tes sensitivitas
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Sampling
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Urine - General
Collection method must avoid contamination
Clean catch, midstream voided
Catheterized urine
Suprapubic aspiration
Cultures performed quantitatively
Less than 10,000 per ml suggest contamination
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Clean Catch, Midstream Urine
Cleanse periurethral area with soap and water
Pass initial urine into toilet, then collect specimen in cup
Instructions to patient are critical
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Pre specimen processing
Instruct the procedures for the patient Specimen collection
Collection of midstream urine for bacterial investigation:
Patient not needing assistance:
Give the patient a suitable container. Instruct the patient before the collection, preferably with illustration. Tell the patient not to touch the inside or rim of the container.
Patient prepartion
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Who will collect the specimen Midstream urine is collected by the patient. If disabled, nursing staff will assist in collection. For catheterized specimen, nursing staff will collect the specimen. Suprapubic aspiration is performed by the physician.
Pre specimen processing
Quantity of specimen To fill line in transport tube (~20 mL).
Time relapse before processing the sample The maximum time allowed for processing a urine sample
is 2 hours from the time of collection.
Storage At room temperature unless delay is inevitable; it must be
refrigerate or mixed with preservative like boric acid.
Suprapubic aspiration
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Instructions for Patient 1. Remove underpants completely so they will not get soiled.
2. Sit comfortably on the seat, but do not leave your knees in front of you. Instead swing one knee to the side as far as you can.
3. Spread yourself with one hand, and continue to hold yourself spread while you clean and collect the specimen.
4. WashBe sure you wash well and rinse well before you collect your urine sample. Wash only the area from which you pass urine. You do not have to wash hard, but wash slowly. Be sure to wipe from the front of your body towards the back. Wash between the folds of skin as carefully as you can.
5. Do not put sponges in the toilet. Put them back in the plate.
6. RinseAfter you have washed with each soap pad, rinse with each moistened pad with the same front to back motion. Do not use any pad more than once.
7. Hold cup by the outside and pass your urine into the cup. If you touch the inside of the cup or drop it on the floor, ask the nurse to give you a new one.
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Sample Collection (supra pubic puncture)
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Sample collection (in situ cathether)
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Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin
Sampel
Pemeriksaan Makroskopis
Pemeriksaan Mikroskopis
Kultur
Tes sensitivitas
-
Specimen processing
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The use of dipstick designed to detect the presence of urine nitrite and to
indirectly estimate the number of segmented neutrophiles through the detection
of leukocyte esterase activity. Rationale for the nitrate test is that most urinary
tract infections are caused by nitrate reducing members of the family
Enterobacteriaceae.
Leukocyte esterase (LE) is produced by segmented nutrophiles; this test when
performed alone correlated with ten or more white blood cells per high power
field in the urine with a sensitivity in the range 88% and specificity 94%.
Initial report
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Pyuria
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Pyuria: the increased number of WBC in urine sample. sterile pyuria: is a condition arises when there is an elevated in WBC in urine and negative culture.
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Screening test
As many as 60% to 80% of all urine specimens received for culture by the
acute care medical Center laboratory may contain no etiological agents of
infection. Procedure developed to identify quickly those urine specimens that
will be negative on culture, thus to circumvent excessive use of media,
technologist time, and the overnight incubation period. The gram stain is the
easiest, least expensive, and probably the most sensitive and reliable
screening method for identifying urine specimens that contain greater than
10^5 CFU/ml.
A drop of well-mixed urine is allowed to air dry.
The smear is stained and examined under oil immersion (1000x).
Presence of at least one organism per oil immersion field.
( examining 20 fields ) corelates with significant bacteriuria (>10^5 CFU/ml).
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Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin
Sampel
Pemeriksaan Makroskopis
Pemeriksaan Mikroskopis
Kultur
Tes sensitivitas
-
Mix the urine sample to re-suspend microorganism present.
Dip a 1 l or 10 l calibrated loop in vertical position in the urine and remove the loop and use the collected fluid to inoculate Nutrient, Blood and MacConkey
agars respectively.
Culturing Procedure
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Culturing Procedure
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A plate count of 100,000 CFU/ml of pure culture should be considered positive and isolated organism should be identified and sensitivity test will be
performed.
A plate count between 10,000 100,000 CFU/ml is considered suspected . A plate count less than 10,000 CFU/ml is considered negative.
ml) in plated, (volume (dilution)
counted colonies # sample original in
ml
CFU
Colony counting
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Sistematika Presentasi
Indikasi Pemeriksaan Kultur Urin
Sampel
Pemeriksaan Makroskopis
Pemeriksaan Mikroskopis
Kultur
Tes sensitivitas
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Metode kultur baru
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Bacturcult Urine Culture Tube
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Conventional Urine Dipslides
No of colonies: up to 3 4 - 10 11 - 20 21 -50 over 50
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UTI-SET SYSTEM NOVAmed Ltd
DipStreak
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Interpretation
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Interpretation of Quantitative Culture